The Great and Powerful

Well, I did it. It wasn’t easy, but I did it. But that comes later.

Yesterday, Forbes sponsored a Health Care Summit. It was a fascinating day-long conference featuring some of the most innovative minds in health care, policy, and technology, especially in the private sector. And me.

The tech stuff was very, very cool, but probably doesn’t actually address the immediate needs of the health care system—delivery of better, more cost-effective care to more people. But it was an interesting glimpse into the future.

I got to ask Governor Rick Perry of Texas a question during Q&A. Steve Forbes interviewed him about a health care boom in his state. Governor Perry is a pretty impressive guy. He’s tall and thin and folded himself into his chair a bit like a mantis, all angles and articulations. And I could see why a presidential run might not have suited him. Aside from the fact that I disagree with nearly all his policy ideas, he sat very much like a person with chronic back pain, one hand bracing him on the arm of the chair. I’d imagine Jack Kennedy looked similar, a mixture of pain, intelligence and charm.

But Perry is no Jack Kennedy. He emphasized his states ability to attract doctors and researchers through tax cuts, tort reform, and other classically Republican economic ideas (not that I’m gonna complain about tort reform).

So I asked him, “Governor, what percentage of all of these doctors coming to Texas are primary care docs? Because we have a shortage. Only 4% of American medical grads choose primary care, mostly for economic reasons. How will you get PCP’s down there?”

He admitted he didn’t know much about the numbers, but that he was considering incentives including paying for education in exchange for service. This has always been a good idea, but our system doesn’t make it worthwhile. Almost any specialist can make enough in a short period of time to pay off their loans, so unless you are drawn to primary care strongly enough, the economics don’t work out.

Still, the dude answered the question directly. Maybe his policies help the Texas economy, but they aren’t going to scratch the real health care problems. Like most policy makers, he doesn’t seem to understand where the real problems lie.

I gad a great conversation, which I hope to continue, with the President of the Joint Commission, Mark Chassin. I learned a ton about the Commission I hadn’t known. For the non-medical peeps, the Joint Commission is a private entity that accredits US hospitals, assessing them for safety, quality, etc. A failure to pass a JACHO inspection is a very, very big deal, and when they’re in the house, entire hospital staffs tend to lose their shit.

To those of us on the ground, many of the JCAHO policies seem insane (and many of them probably are). Hospitals will prepare docs by giving them copies of the institution’s “mission statement” so it can be dutifully recited to inspectors.

What concerns me more than mission statements is quality. We had a little chat about initiatives that JACHO has offered hospitals to, for example, make transitions from hospitals to home or nursing homes safer. Right now, when a patient of mine leaves the hospital, they, and I, get a many-page discharge document that no normal person could ever understand (and I include myself in that category).

Much of the reason for this sort of thing is hospital efforts to meet JCAHO and Medicare standards, standards that are often confounded with each other, an effort that is usually ham-fisted and non-sensical. It’s not supposed to be that way.

As I gather my thoughts, I hope to share with you more from the conference, but first…

The night before, Steve Forbes hosted a reception at his offices. The surprise of the evening was an appearance by Dr. Mehmet Oz, one of the most disruptive forces in medicine, and someone who in my opinion, confounds sideshow barker nonsense with real medical science. He gave what was supposed to be an inspirational talk, but really, he just rambled from topic to topic, often contradicting himself. And everyone was starstruck.

It seems famous people like other famous people for being famous. I cannot think of a thing Dr. Oz has to offer American health care, other than his retirement from public life. But they flocked to him in the low-ceilinged gallery, jostling each other in the close space as if fighting for a New York cab, the kind that’s never around when you need it.

I blame David Kroll for egging me on. I nudged slowly through the crowd of admirers and introduced myself, as a “fan and a critic.” I told him I was a fan of his ability to communicate, but that my patients don’t bring to me the message he thinks he’s delivering. They would rather find some raspberry ketone than exercise and eat better.

“I don’t sell any products. People use my image. Blah blah.”

I thanked him for his time and nudged my way back out of the crowd.

The telling moment for me was during his speech. He closed with a joke, about a patient who had made use of a ton of “complementary medicine” during her hospital stay. When confronted with the bill, she replied, “but it’s complementary!

That’s not funny. Health care is expensive, people struggle to pay their bills and are terrified for their lives. To joke about billing them for services that are worse than useless, like reiki and acupuncture, is cruel and shows a lack of compassion.

Old Geezer

saffronrose

Sometimes I’m star-struck–standing next to skater Peggy Fleming in the checkout line at a cooking boutique, wanting to give her privacy, but wishing I had something intelligent and out-of-the-ordinary to say.

There are some “celebrities” away from whom I would run if they were nearby. I was at a trade show when Mike Tyson appeared. Some boothies nearby were fawning all over him, but had he come any nearer to where I was waiting, I would have looked him up and down, turned my back and left without getting to meet the person for whom I waited. Batterer, short on anger management, and not following medical advice for his bipolar disorder–why on earth would that be attractive to anyone (YMMV)?

I do hope you were able to wash your hands after, as Old Geezer suggested. I might have needed a long hot shower after, myself, just being in the same room, in order to get the cooties out.

DLC

Dr Oz. no more apt name has been applied. He rose to fame on Oprah Winfrey’s coattails along with Dr Phil and a couple others. While I might admire Ms W’s business acumen, I sincerely doubt her critical thinking skills. She does psychics, faith healers and quacks, to the point I cringe every time I see an ad for one of her programs on her cable channel.
Dr Oz is possibly worse than all the Quacks and Psychics, because he’s supposed to know better. He should stop, wake up and smell the coffee instead of the money.

My husband (a pediatrician) was reading this post the other day & we both wondered: is it really true that only 4% of docs now go into primary care? (Are you counting just GPs, or are you including pediatricians? Gynecologists now claim that they offer ‘primary care’ services to women.) Who’s included in your 4%?